Provider Demographics
NPI:1467712190
Name:FAMILY MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:FAMILY MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREASSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:907-895-5100
Mailing Address - Street 1:HC 60 BOX 4860
Mailing Address - Street 2:
Mailing Address - City:DELTA JUNCTION
Mailing Address - State:AK
Mailing Address - Zip Code:99737-9440
Mailing Address - Country:US
Mailing Address - Phone:907-895-5100
Mailing Address - Fax:907-895-5133
Practice Address - Street 1:2360 SERVICE STREET
Practice Address - Street 2:
Practice Address - City:DELTA JUNCTION
Practice Address - State:AK
Practice Address - Zip Code:99737-9440
Practice Address - Country:US
Practice Address - Phone:907-895-5100
Practice Address - Fax:907-895-5100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2011207P00000X, 207Q00000X, 208100000X
AK5146207P00000X, 207Q00000X
AK980363A00000X
AK441363A00000X
AK883363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty